硬脊膜囊横截面积是老年患者行经尿道前列腺切除术行椎管内麻醉的一个非常有效的参数：一项前瞻性、双盲、随机研究。
Dural sac cross-sectional area is a highly effective parameter for spinal anesthesia in geriatric patients undergoing transurethral resection of the prostate: a prospective, double blinded, randomized study.
机构信息
Department of Anesthesiology, The Affiliated AnQing Hospitals of Anhui Medical University, 352th, Renming Road, AnQing, 246003, AnHui province, China.
出版信息
BMC Anesthesiol. 2020 Jun 3;20(1):139. doi: 10.1186/s12871-020-01059-x.
BACKGROUND
Spinal anesthesia is optimal choice for transurethral resection of the prostate (TURP), but the sensory block should not cross the T10 level. With advancing age, the sensory blockade level increases after spinal injection in some patients with spinal canal stenosis. We optimize the dose of spinal anesthesia according to the decreased ratio of the dural sac cross-sectional area (DSCSA), the purpose of this study is to hypothesis that if DSCSA is an effective parameter to modify the dosage of spinal anesthetics to achieve a T10 blockade in geriatric patients undergoing TURP.
METHODS
Sixty geriatric patients schedule for TURP surgery were enrolled in this study. All subjects were randomized divided into two groups, the ultrasound (group U) and the control (group C) groups, patient receive either a dose of 2 ml of 0.5% isobaric bupivacaine in group C, or a modified dose of 0.5% isobaric bupivacaine in group U. We measured the sagittal anteroposterior diameter (D) of the dural sac at the L3-4 level with ultrasound, and calculated the approximate DSCSA (A) according to the following formula: A = π(D/2), ( π = 3.14). The modified dosage of bupivacaine was adjusted according to the decreased ratio of the DSCSA.
RESULTS
The cephalad spread of the sensory blockade level was significantly lower (P < 0.001) in group U (T10, range T7-T12) compared with group C (T3, range T2-T9). The dosage of bupivacaine was significantly decreased in group U compared with group C (P < 0.001). The regression times of the two segments were delay in group U compared with group C (P < 0.001). The maximal decrease in MAP was significantly higher in the group C than in group U after spinal injection (P < 0.001), without any modifications HR in either group. Eight patients in group C and two patients in group U required ephedrine (P = 0.038).
CONCLUSIONS
The DSCSA is a highly effective parameter for spinal anesthesia in geriatric patients undergoing TURP, a modified dose of local anesthetic is a critical factor for controlling the sensory level.
TRIAL REGISTRATION
This study was registered in the Chinese Clinical Trial Registry (Registration number: ChiCTR1800015566).on 8, April, 2018.
背景
椎管内麻醉是经尿道前列腺切除术（TURP）的最佳选择，但感觉阻滞不应超过 T10 水平。随着年龄的增长，一些椎管狭窄患者在椎管内注射后，感觉阻滞水平会升高。我们根据硬脊膜横截面积（DSCSA）的减小比例来优化椎管内麻醉的剂量，本研究的目的是假设 DSCSA 是否是修改椎管内麻醉剂剂量以实现接受 TURP 手术的老年患者 T10 阻滞的有效参数。
方法
本研究纳入了 60 例拟行 TURP 手术的老年患者。所有患者随机分为两组，超声组（U 组）和对照组（C 组），C 组患者接受 2ml 0.5%等比重布比卡因，U 组患者接受改良剂量的 0.5%等比重布比卡因。我们用超声测量 L3-4 水平硬脊膜矢状前后径（D），并根据以下公式计算近似的 DSCSA（A）：A=π（D/2），（π=3.14）。根据 DSCSA 的减少比例调整布比卡因的改良剂量。
结果
与 C 组（T3，范围 T2-T9）相比，U 组（T10，范围 T7-T12）感觉阻滞水平的头侧扩散明显较低（P<0.001）。与 C 组相比，U 组布比卡因的剂量明显减少（P<0.001）。与 C 组相比，U 组两个节段的回归时间延迟（P<0.001）。与 U 组相比，C 组脊髓内注射后 MAP 的最大下降幅度明显更高（P<0.001），两组的 HR 均无变化。C 组 8 例和 U 组 2 例患者需要麻黄碱（P=0.038）。
结论
DSCSA 是 TURP 老年患者椎管内麻醉的一个非常有效的参数，局部麻醉剂的改良剂量是控制感觉水平的关键因素。
试验注册
本研究在中国临床试验注册中心注册（注册号：ChiCTR1800015566），于 2018 年 4 月 8 日。
Zotero 插件